Resources for general practitioners
GPs participating in the ANSC program are provided with a suite of resources developed in conjunction with the Sydney Local Health District (SLHD) maternity facilities in an effort to provide consistent care for GP shared care patients.
Additional pregnancy-related infomation can be viewed on Sydney Healthpathways
The ANSC GP Resource Manual is intended as a guide for general practitioners participating in the SLHD Antenatal Shared Care Program. The manual's content is linked with HealthPathways where relevant.
pdf
ANSC GP Resource Manual v 8.0. (October 2018)
(5.19 MB)
On opening PDF file, Click Bookmark Icon 
to view contents page and navigate through the manual. The Bookmark Icon will appear on top bar ( right hand side) or side bar ( left hand side), depending on browser.
Response to COVID-19. A revised antenatal protocol will be available shortly.
In the meantime, current GP ANSC protocol should be followed with scheduled GPs visits in accordance with your individual practice procedures at this time and patient assessment
GPs participating in the ANSC program will be expected to adhere to the agreed guidelines as outlined in the SLHD ANSC Protocol when caring for their antenatal shared care patients.
pdf
SLHD Antenatal Shared Care Protocol - Antenatal Clinic
(704 KB)
( September 2018)
pdf
SLHD Antenatal Shared Care Protocol - Birth Centre
(122 KB)
( September 2018)
Breaches of the ANSC Protocol that affect patient outcomes will be recorded for quality assurance purposes. Any investigations requested by the GP for a woman under his/her care must be followed up by the GP concerned. At all times it is the primary responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up management and communication, irrespective of whether a copy has been sent to the participating hospital.
The aim of EPAS is to identify and manage ectopic pregnancies, vaginal bleeding in pregnancy, or miscarriage less than 20 weeks gestation. The service is available to assist you with the management of your haemodynamically stable patient.
If patient is clinical unstable and less than 20 weeks pregancy, arrange immediate transfer to relevant hospital Emergency Department
Urgent review for pregnant patients < 20 weeks gestation, contact relevant hospital on-call Gynaecology Registrar
Contact relevant hospital on-call O&G Registrar for all pregnant patients > 20 weeks gestation.These women should be sent to hospital Delivery Ward
Patient must:
- be less than 20 weeks pregnant,and
- have abdominal pain or vaginal bleeding,and
- be experiencing only mild to moderate symptoms,
or
- have an incomplete miscarriage or threatened miscarriage, confirmed by ultrasound
Women attending Canterbury Hospital who fulfill referral criteria (and willing to travel) may be referred to EPAS at RPAH or St George Hospital
Exclusion criteria
- Patient more than 20 weeks pregnant – ph. Obstetric Registrar (02) 9515‑6111 for management in the Delivery Ward.
- Termination of pregnancy
- Dating scans
- Management of hyperemesis
Referral advice
For advice or guidance regarding patient referral, please contact Clinical Midwifery Consultant (CMC) Mon - Sun 08.00am-4.00pm Ph: 0429 728 608 Fax 9515 3454 (Health Professionals ONLY). There is no need to contact CMC for all EPAS referrals, only if further referral advice is required.
For all other non early pregnancy/gynaecological issues, please contact hospital O&G Registrar ph. 9515 6111.
Required information
- Pathology copy of blood group result
- Most recent serum quantitative BHCG where available
- Any previous ultrasound results
- Significant medical history
- RPAH Fetal Medicine ultrasound referral form
- Complete EPAS Referral Form and give to patient to take to clinic
Inform the patient
- Must present to the Women’s Ambulatory Care Reception (Level 5) at 7.30 am (Mon- Fri) the next business day.
There are no appointment times and waiting times will vary. - Preparation requirements – a full bladder is not required and fasting from midnight is preferable.
- If the patient consents, a report will be mailed to the general practitioner on the day of consultation. Patient Brochure -
pdf
RPA
(283 KB)
pdf
Early bleeding in pregnancy
(283 KB)
Fetal movements are a reliable indicator of fetal well-being. Any maternal reporting of a change in fetal movements should be taken seriously and assessment arranged as soon as possible.
RPA Women and Babies -
pdf
Decreased fetal movements guidelines
(117 KB)
Movements matter - comprehensive suite of resources for both health professionals and consumers developed by the Centre of Research Excellence in Stillbirth. Translated information also available Safer Baby Bundle- online learning module developed by the Centre of Research Excellence in Stillbirth covering 5 elements : Smoking Cessation, Fetal Growth Restriction (FGR), Decreased Fetal Movements (DFM), Side Sleeping and Timing of Birth. Maternity - Decreased Fetal movements in third trimester - NSW Health Guidelines
pdf
Diagnostic Testing for Hyperglycaemia in pregnancy
(504 KB)
- resource which includes defining risk, screening protocol, interpreting results, postnatal follow-up and pre-pregnancy assessment
pdf
Glucose Tolerance Test (GTT) Instructions
(149 KB)
- patient instruction for GTT testing ADIPS - Australian Diabetes In Pregnancy Society- Resources for both health professionals and patients
Early identification of women experiencing psychosocial problems and mental health conditions in the perinatal period it important so they can recieve timely support and care.
pdf
Mental Health Care in the Perinatal Period - Australian Clinical Practice Guideline
(681 KB)
- Centre of Perinatal Excellence (COPE) COPE Centre for Perinatal excellence - provides resources for both health professionals and consumers Screening and assessment tools : Including psychosocial risk assessment (ANRQ/PNRQ) , assessment of depression and anxiety (EPDS. Includes D&A and D&FV questions , assessing mother and child interaction
pdf
Looking after your perinatal mental health
(611 KB)
- Information for patients beyondblue - provides access to a variety of information regarding perinatal mental health
Clinical Services
Psychological Support Services (PSS)
PSS provides FREE short term face-to-face psychological services to people living in the CESPHN region. Priority groups include women experiencing perinatal depression from conception to 12 months after birth.
For more information visit our PSS page
St John of God Medical Centre
Free Medicare fund Psychiatrist service for women in the perinatal period that cannot afford a consult with a private psychiatrist.
The clinic provides short term assessment, therapy, and treatment plan and the woman is referred back to the GP for ongoing management
For more information and referral processes visit
pdf
Clinic Information
(476 KB)
and
pdf
GP Referral Form
(261 KB)
All women, regardless of age should be counselled and offered the option for screening for chromosomal anomalies.
Antenatal Shared Care GPs can refer women directly to the Fetal Medicine Unit (Phone: 9515 6042) for the following tests:
- Combined First Trimester Screening (cFTS)
- Non-Invasive Prenatal Screening (NIPT)
- Chorionic Villus Sampling (CVS)
- Aminocentesis
Referral forms are required to be completed for referral for these tests. Women should contact FMU to arrange appointment Ph: 9515 6042
Timing of procedures| Procedure | Gestation (wks) |
| Non- Invasive Prenatal Testing (NIPT) | 10 weeks onwards |
| Combined First Trimester Screening (cFTS) | 11+1-13+6 |
| Chorionic Villus Sampling (CVS) | 11-13 |
| Amniocentesis | 15-19 |
The Fetal Medicine Unit (FMU) at RPA Women and Babies routinely offers Combined First Trimester Screening (cFTS): ultrasound scan (nuchal translucency and nasal bone) plus biochemistry to pregnant women booking for delivery at RPA Women and Babies and Canterbury Hospitals
Referral for cFTS:
- Complete FMU Ultrasound Referral Form (yellow)
- Complete pdf RPAH First Trimester Screening Pathology Form (157 KB) - advise woman that blood can be collected from 11 weeks until at least 3 days prior to ultrasound appointment. It should be collected at either RPAH or Canterbury Hospital Pathology Department
- Provide woman the
pdf
First Trimester Screening Patient Information Sheet
(127 KB)
which outlines screening test procedure
- Provide relevant Patient Information Brochures
pdf
cFTS
(285 KB)
pdf
NIPT
(537 KB)
pdf
CVS & Amniocentesis
(358 KB)
- Advise woman that her results will be available at time of U/S appointment (ensuring that blood has been collected prior )
Access to Non-Invasive Prenatal Testing (NIPT) will be as a second line screening tool for women at high or intermediate level of risk after cFTS. The NIPT test is not available through Medicare and women will have to fund this test themselves. For further information contact the RPA Genetic Counsellors ph 9515 5080 or Fetal Medicine Unit ph 9515 6042
Resources
Patient Brochure- Screening tests for your baby in early pregnancy- NSW Health: Centre for Genetics Education
Patient Brochure- Prenatal testing booklet - NSW Health : Centre for Genetics Education
RACGP - Genomics in general practice RACGP - Reproductive carrier testing First Trimester Sceening Learning Module: NSW Centre For Genetics: On-line education module Search for Certified Operators to perform Nuchal Translucency - RANZCOG Nuchal Translucency: Ultrasound, education and monitoring program
Translated material regarding genetics, prenatal testing and pregnancy are located at the Multicultural Health Communication Service - NSW Health.
pdf
Thyroid Disease Guidelines and referral flowchart
(390 KB)
: Who to screen, Thyroid Function Test Reference ranges in pregnancy, Referral criteria
Revision of Thyroid Services in response to COVID -19 : Effective 30/3/2020
In order to minimise the number of visits and time spent in hopsital , all consultations will henceforth be provided by telecommunication only.
Please refer to the following resources to guide clinical management : Referral Flowchart (above) and Sydney Healthpathways - Thyroid Disease in pregnancy
For any clinical concerns, please contact Dr Ash Gargya or Julie Hetherington in the Endocrinology and Metabolism Clinic ph. 9515 7225.
Get Healthy in Pregnancy ( NSW Health) - Free telephone-based service to support all women about eat healthily, getting active and maintaining a healthy weight during pregnancy
Eat For Health ( Australian Government) - Healthy eating during pregnancy - Consumer brochure
GBS screen should be collected at 34-36 week GP visit .It needs to be collected PRIOR to hospital review at 37 weeks.
The GBS screening LVS can be attended as a pdf patient self- collection (1.65 MB)
Identifying women who are at risk of having a baby with GBS enables treatment to be given intrapartum to prevent transmission of infection to the baby. Discussion about GBS should take place at around 35 weeks gestation so that women have received information about preventive treatment before they go into labour.